Patient Safety: Hospital acquired infections – time for patients to step up

By Susan D. DeVore

Healthcare-acquired infections (HAIs) take a real toll, affecting nearly 2 million patients a year and resulting in more than 100,000 deaths. In fact, infections are one of the top 10 leading causes of death in the United States, killing more people than AIDS, breast cancer, plane crashes and auto fatalities combined.

Although providers are making real progress to reduce preventable infections, they must continue to do more – both to enhance the lives of the patients they treat and to avoid punitive measures that could affect reimbursements at a time when so many are struggling to stay afloat. For instance, hospitals face state-based initiatives aimed at preventing HAIs, including mandatory reporting. There’s also CMS’s current policy, which withholds payments for complications resulting from HAIs. And recently, provisions were introduced in health reform legislation that would reduce reimbursements for hospitals as part of a stand-alone HAIs measure and as part of value-based purchasing (VBP).

All these policies add up to a situation where hospitals could be penalized multiple times for the same infection through state reporting requirements, CMS policy, value-based purchasing and new stand-alone HAI measures.

Preventing infections doesn’t have to require a major investment in new programs, technologies and staff. There is a low-tech solution that we know can significantly reduce infections and their associated costs: improving hand hygiene. We’ve known since the 1800s that hand hygiene prevents the spread of illnesses, including HAIs. Yet healthcare workers follow the CDC guidelines for hand hygiene less than half the time, particularly when they become busy and forgetful. So the natural solution is to try innovative approaches to help jog their memories.

One such approach is to partner with patients. Last year, the CDC released a patient education video called “Hand Hygiene Saves Lives.” The video teaches patients, family and visitors to request that healthcare professionals perform hand hygiene by washing hands with soap and water or using an alcohol-based hand rub before and after touching patients.

Did it work? Yes, according to research conducted by CDC, the Premier healthcare alliance and the Catholic Healthcare Partners, and facilities that agreed to show the video. Twice as many patients who saw the video were willing to remind caregivers to wash their hands than those who didn’t. In one case, a hospital visitor got so engaged that she chased a doctor who had forgotten to disinfect his hands down the hall to remind him. These findings suggest an important role for patients as advocates for the safety and effectiveness of their care – an oft-forgotten audience that government solutions rarely address.

I believe a reminder from patients will prove to be a thousand percent more effective in improving compliance with hand hygiene protocols than payment cuts after the damage is already done. And what’s more, it’s the responsible thing, as it prevents the infections from occurring in the first place. Government has an important role to play in improving healthcare quality and reducing HAIs, but I think getting patients involved may be the best answer.

Susan D. DeVore is president and CEO of the Premier healthcare alliance, a 2006 Malcolm Baldrige National Quality Award recipient.